The induction of specific proteases for insulin-like growth factor-binding proteins following major heart surgery.

Insulin-like growth factors (IGF-I and IGF-II) circulate bound to specific high-affinity binding proteins (IGFBPs). Recent evidence has shown that in pregnancy and severe illness, specific proteases modify these binding proteins, reducing their affinity for IGFs. We have studied 12 patients, undergoing elective coronary artery vein-bypass graft surgery, for the appearance of these proteases and have demonstrated the induction of two independent, heat-labile, cation-dependent proteases. Proteolytic activity directed against IGFBP-3 was detected in all patients between 24 h and 5 days after surgery; the second IGFBP-4 specific protease was active 1 h after sternotomy. The total IGF-I levels were found to decrease following surgery, with the IGF-I distribution in the plasma being radically altered from that seen prior to the operation. One day after the operation the majority of the IGF-I, instead of being bound in the relatively inert 150 kDa complex, was associated with the smaller binding proteins which are more readily accessible to the tissues. These findings are in contrast to pregnancy where, despite similar proteases, the majority of the IGF-I remains in the 150 kDa complex. The alteration seen in IGF-I distribution after surgery did not appear to be a direct result of the IGFBP-3 proteolytic activity or an effect of the addition of heparin to the circulation. The potential increase in bioavailability of IGFs caused by the alteration in carrier protein may play a pivotal role in countering the catabolic state induced by surgery.

Intraoperative assessment of atracurium-induced neuromuscular block using double burst stimulation.

Paired train-of-four (TOF) and double burst stimuli (DBS) were administered to the ulnar nerve at the wrist in 25 patients (group 1) paralysed with atracurium 0.5 mg kg-1; responses were measured mechanically (except every third DBS response which was manually evaluated). Another 30 patients (group 2) received a DBS every 60 s. A post-tetanic count (PTC) was performed when the first response (D1) was palpated. There was a significant correlation between the twitch heights of the first TOF response (T1) and D1 and likewise between the twitch heights of both second responses (r = 0.9; P less than 0.001), but there was a significant difference in regression coefficients of these two correlations (P less than 0.001). D1 was palpable first with a median PTC of 7. Our results showed that palpation of a single response implied a satisfactory level of paralysis. DBS may be useful for intraoperative clinical monitoring of neuromuscular block.

Parents and paediatric anaesthesia: a prospective survey of parental attitudes to their presence at induction.

Parental presence at induction of anaesthesia is controversial and of disputed value. Ninety out of 117 parents replied to a preoperative questionnaire designed to identify their preference and motivation with regard to accompanying their children to the anaesthetic room. Half the parents wished to be present at induction, irrespective of the child's age or previous surgical experience and the most commonly cited reasons for this were the child's anxiety or the parents' sense of duty; 32% of these parents changed their preference if their child were to be adequately sedated preoperatively. In addition, 18% of all parents felt that they would prefer not to be present at induction. The results suggest that in circumstances where parents are to be excluded from induction, adequate preoperative explanation and sedative premedication would contribute to allaying parental anxiety, but that a flexible policy may be most appropriate.

[The study of experimental and natural rotavirus infection in mice using a heterologous enzyme immunoassay test-system]. / Izuchenie éksperimental'noi i estestvennoi rotavirusnoi infektsii myshei s pomoshch'iu geterologichnykh test-sistem immunofermentnogo analiza.

Enzyme immunoassay test systems constructed on the basis of heterologous calf and monkey rotaviruses were shown to be applicable for diagnosis and study of the pathogenesis of experimental and natural rotavirus infection of mice.

Total respiratory compliance during anaesthesia in infants and young children.

The multiple occlusion technique was used to study the effects of paralysis on ventilatory mechanics during anaesthesia. Total respiratory compliance (Crs) was measured during spontaneous breathing and following neuromuscular block with controlled ventilation in 23 infants. There was marked variation in response to paralysis: some infants demonstrated no change in Crs between the two states; others had values of Crs which were significantly higher during paralysis with controlled ventilation than during spontaneous breathing. A possible cause of these differences may be the type of controlled ventilation given during paralysis, with tidal volume directly influencing values of Crs obtained. The results of this study suggest that values of Crs obtained during spontaneous breathing and paralysis should not be used interchangeably until further studies have been performed to assess factors influencing Crs during controlled ventilation.

The pressor response and laryngeal mask insertion. A comparison with tracheal intubation.

The pressor response associated with laryngoscopy and tracheal intubation may be harmful to certain patients. The laryngeal mask airway avoids the need for laryngoscopy and allows positive pressure ventilation of the lungs in appropriate patients. This study compared the pressor response of tracheal intubation with that of mask insertion in two groups of 24 and 23 healthy patients respectively. All patients were anaesthetised with thiopentone, nitrous oxide, enflurane and paralysed with atracurium. We have shown a similar, but attenuated pattern of response associated with mask insertion in comparison with laryngoscopy and intubation; significant differences between the groups were evident in arterial diastolic blood pressure immediately after insertion and again 2 minutes later. Use of the laryngeal mask may therefore offer some limited advantages over tracheal intubation in the anaesthetic management of patients where the avoidance of the pressor response is of particular concern.

Neurogenic pulmonary oedema precipitated by induction of anaesthesia.

Neurogenic pulmonary oedema is a recognized complication of central nervous system injury. A case is presented where this condition was precipitated by induction of anaesthesia in a child with spina bifida, hydrocephalus and a malfunctioning ventriculo-peritoneal shunt.

Post-tetanic count and intense neuromuscular blockade with vecuronium in children.

Sixty children undergoing surgery were allocated, according to weight, to three equal groups. Each child received a loading dose of vecuronium 80 micrograms kg-1 followed immediately by an infusion set initially at 1.4 micrograms kg-1 min-1. The subsequent intense neuromuscular blockade was assessed using the post-tetanic count (PTC). Maintaining the PTC between 5 and 15 ensured adequate paralysis which was antagonized easily 6-18 min after stopping the infusion. However, the duration of the initial intense block was unpredictable and the use of a peripheral nerve stimulator is advisable, particularly in smaller infants (less than 5 kg). The results suggest that vecuronium accumulated after 3 h infusion and that has less presynaptic effect than atracurium.

[Enzymatic activity of peripheral blood cells in experimental chronic myocarditis caused by persistent Coxsackie A virus]. / Enzimaticheskaia aktivnost' kletok perifericheskoi krovi pri éksperimental'nom khronicheskom miokardite, sviazannom s persistentsiei virusa Koksaki A.

Molecular mechanisms of metabolic modifications in blood cells were found to be associated with immunological tolerance to Coxsackie A virus in the modelling of chronic systemic diseases in rats. Blood cellular enzymatic activity correlated with morphological damage in internal organs. Cytochemical analysis is an informative test for investigating destructive and inflammatory changes in the affected organs.

[Enzyme profile in the peripheral blood leukocytes in acute respiratory diseases]. / Izuchenie fermentnogo profilia v leikotsitakh perifericheskogoi krovi pri ostrykh zabolevaniiakh organov dykhaniia.

The character of changes in the enzymatic activity of peripheral blood leukocytes indicate the activity and severity of the process and may serve as data for the prognosis of the course of the disease and for the evaluation of the effectiveness of antibacterial and desensitizing therapy.

[Isolation of influenza A viruses with a new antigenic formula from wild birds]. / Izoliatsiia virusov gripopa A s novoi antigennoi formuloi ot dikikh ptits.

Three hemagglutinating agents were isolated from mixed pools of the viscera from black-headed gulls (Larus ridibundus) and robin (Erithacus rubecula) collected in the Byelorussian SSA and the Kaliningrad region of the RSFSR. Typing of the viruses by double immunodiffusion technique revealed antigenic relationships of the viruses with swine hemagglutinin (Hsw1) and human hemagglutinin H0. One of the strains had neuraminidase N2 the other two Nav2. An analysis of the polypeptide composition of the virus showed the molecular weights of the heavy (HA1) and light (HA2) hemagglutinin chains to be similar in both strains (about 50,000 and 25,000 daltons, respectively). The strains had a low content of the light hemagglutinin chain (HA2) which is typical for viruses having Hsw1 hemagglutinin.

[Properties of Hav6Neq2 and Hswl(H0)Hav2 influenza viruses isolated from waterfowl in southern Turkmenia]. / Svoistva virusov grippa Hav6Neq2 i Hswl(H0)Hav2, izolirovannykh ot ptits okolovodnogo kompleksa na iuge Turkmenii.

Three influenza A virus strains were isolated from shorebirds in October, 1977, in southern Turkmenia, in the vicinities of Tedzhen water reservoir. From a common tern, A/Sterna hirundo/Turkmenia/45/77 strain was isolated with the antigenic formula Hav6Neq2, from a teal and a black-headed gull influenza A/Anas crecca/Turkmenia/4/77 and A/Larus ridibundus/Turkmenia/13/77 strains with previously unknown combination of surface antigens Hswl(H0)Nav2 were recovered. By the molecular weight of the heavy (HA1 59,000 d) and light (HA2 24,000 d) chains of hemagglutinin, the Turkmenian viruses A/Larus ridibundus/Turkmenia/13/77 and A/Anas crecca/Turkmenia/4/77 are similar to each other and to the strains having H0 hemagglutinin: A/PR8/34 (H0N1) and A/Whale/PO/19/76 (H09Nav2). The Turkmenian viruses are characterized by a low content of the light hemagglutinin chain (HA2) which is typical of the viruses with Hsw1 hemagglutinin: A/New Jersey/8/76 (Hsw1N1) and A/SW/Wisk/68 (Hsw1N1).

[Isolation of influenza virus from Chlidonias nigra and serologic examination of the birds for antibodies to influenza virus]. / Izoliatsiia virusa grippa ot chernoi krachki (Chlidonias nigra) i serologicheskoe obsledovanie ptits na antitela k virusu grippa.

Influenza A virus with the antigenic formulae Hav4Neq2 has been isolated from Chlidonias nigra in the region of mass moulting in the territory of the Kazakh SSR. Antihemagglutinins for the newly isolated virus were detected in the sera of some specimens of the sea gull order. The data obtained suggest an active circulation of the virus in this region during the summer of 1977.

[Influenza virus A/Anas acute/Maritime Territory/730/76(H3N2) isolated from wild ducks in the Maritime Territory]. / Virus grippa A/Anas acuta/Primor'e/730/76(H3N2), isolirovannyi ot dikikh utok Primorskogo kraia.

A strain A/Anas acuta/Primorie/730/76 was isolated in the autumn of 1976 from wild pintails in the Primorskiy kray, USSR, and found by the H1 and neuraminidase activity inhibition test to be antigenically related to the reference A/Hong Kong/1/68 strain. The CFT showed the A/Anas acuta/Primorie/730/76 strain to contain in its hemagglutinin 3 antigenic determinants: two common with the A/Hong Kong/1/68 strain and one the strain-specific, lacking in the human influenza viruses of the H3N2 antigenic formula.